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Logo of canjcardiolThe Canadian Journal of Cardiology HomepageSubscription pageSubmissions Pagewww.pulsus.comThe Canadian Journal of Cardiology
 
Can J Cardiol. 2009 July; 25(7): e267.
PMCID: PMC2723042

Screening for breast cancer should be an integral part of myocardial perfusion imaging

A 65-year-old woman with a history of myocardial infarction was referred for dipyridamole myocardial perfusion imaging for risk stratification. Stress and rest myocardial images were normal. However, on the nonmagnified raw projection technetium (Tc)-99m sestamibi images of the thorax, there was a focal intense hot spot (arrows in Figure 1) in the outer quadrant of the left breast shown in the anterior (Ant), left anterior oblique (LAO) and left lateral (L Lat) tomographic views, which proved to be a 4.5 cm undiagnosed infiltrating ductal carcinoma (T2N0M0). The lesion in the outer quadrant of the breast (arrows in Figure 2) was even more obvious on the nonmagnified volumetric three-dimensional reconstruction of the thorax, shown in the Ant, LAO and L Lat tomographic views. Tracers used for myocardial perfusion imaging, such as Tc-99m sestamibi, Tc-99m tetrofosmin, F-18 fluorodeoxyglucose and others, have a high affinity for tumours including breast and lung cancer with a sensitivity in excess of 85% for the detection of primary tumours (14). In the United States alone, it is estimated that there were 275,000 new cases of breast cancer in 2006, and more than six million myocardial perfusion studies are performed annually. Image processing is usually performed by nuclear medicine technicians. Physicians who interpret the studies usually only look at the processed and magnified images of the myocardial slices, and dismiss breast activity as a nuisance (an ‘artefact’), which is equivalent to not reporting and disregarding more than six million screening scintimammograms annually. Screening for breast and lung cancer should be an integral part of myocardial perfusion imaging.

REFERENCES

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